Ron, assuming the driver's side is equally buggered up, I wouldn't attack the doors as plan A. Instead I would remove the rear window glass and then working from the bed of the truck, I'd remove the rear of the cab/front of the bed with recip saws. Starting at the top and cutting down and across at the base of this panel. Done it a few times in training and it's worked well. Then we'd attempt to recline the seatback and slide him out the back onto a longboard. Plan B may be removing the roof with a vertical patient removal. Just my inital impressions, good scenario..

I agree with Kbud, with a slight difference that I might elect to include removal the roof after entry through the rear is made during plan A, but that is more than likely just personal preference opposed to any other reason.(Depending on severity of the patient and time constraints)

Through the back was the first thought I came up with.
Used that in the past and it works well. I agree with
removing the roof is you have the rescuers...tall rescuers
at that. But another question. Are the legs trapped? Looks
like this wreck would be a good candidate for it. If so,
I'm still looking at going in the back (no twisting of
the patient). but we may also be looking at a door removal
and dash LIFT. Not sure a dash push would work very well.
Good wreck Ron, but being a Ford man myself, I would like
to think it hit a Peterbuilt instead of a Dodge.

How about this...
Remove the roof for patient access/c-spine, then...with the rear window removed, how about cutting the front of the box out, then openning the rear of the cab through the created openning of the box?

My posts reflect my views and opinions, not the organization I work for or my IAFF local. Some of which they may not agree. I.A.C.O.J. member
"I ask, Sir, what is the militia? It is the whole people. To disarm the people is the best and most effectual way to enslave them."
George Mason
Co-author of the Second Amendment
during Virginia's Convention to Ratify the Constitution, 1788Elevator Rescue Information

Rescuers need to get out of the frame of mind that a KED is for non critical only. The KED can be used as an aid in lifting also, not only in immobilization. A KED can be fitted as a lifting aid, without going to full immobilization of the casualty.

Steve Kidd wrote a great article on exactly this in FIRE RESCUE around the start of last year. Well worth the read if you can get a hold of it. (Fit KED as normal doing up both groin straps and all coloured straps and you suddenly have a device that holds the casualty in place and gives the rescuer some great handles for lifting. Can be fitted in around 2 minutes with 2 trained operators. Another couple of minutes of work and it can be set up for full immobilization.)

Extrication of this magnitude may also take a while to complete, so if there is adequate access to the casualty, then why not fit a KED? You can be assured there is definetly a risk of spinal injury in this impact, we should ultimately aim for the best outcome for the casualty.

Sometimes you must adapt to the situation at hand, and if the only method is the use of the KED then use it. I was on the flip side about 5 years ago when I was involved in a serious accident in which I totaled my pick-up, I was flown out by lifestar...the only way for them to remove me from the vehicle was by KED....no complaints here. Although I have never been advised that the use of a KED was non-critical only...?? interested if you have more info on that. ET

KED

There is no doubt based on current research that using the KED in its fullness on a time-critical patient who is not trapped and can be immediately extricated, would be delaying the golden hour and potentially decreasing survival chances.

However sometimes we use a device for years, following strictly to the manufacturers instructions, never deviating or experimenting with device, and therefore never really learning the true value and uses of the device. The KED is one such peice of equipment.

As a lecturer for the Victorian Ambulance Service on Spinal care, I have for the last 7 years been teaching the use of the KED for a range of uses other than for just spinal splinting. Probably the most popular usage is using the KED as a lifting device in MCAs as lutan suggested. It can be rapidly applied in under 2 minutes, and the time saving for the extrication even on a time critical patient is surprising, as the amount of vehicle cutting required to get the patient out is often less. We apply only the green, red and groin straps.

To teach students the true value of the KED, students spend a day undertaking some 20-30 extrications in a range of damaged vehicles and extricated with the KED in situ and without. It only takes a few go for students to understand the significant benefits of a KED in it's limited application (green, red and groin straps only) through ease of handling of the patient, and ease of removing the patient.

In doing this extrication day, students learn very quickly that the way out of the vehicle is in a direction that maintains spine alignment and minimises body twisting, thus preventing further injury. I guess this answers the original scenario of Ron Moore. Extrication through the side door in this case potentially puts the patient at risk for further injury. Rear extrication is the clinically correct method of extrication.